In the rural village of Njagbahun, Sierra Leone, an abandoned building has been repurposed into a makeshift clinic where nurses offer essential reproductive health services. Operated by Marie Stopes International (MSI), the clinic provides free contraception and post-abortion care to women in hard-to-reach areas, addressing a critical gap in healthcare access.
Among those seeking care is 25-year-old Mariama Soriba, who stepped away from the bustling market to receive a birth control implant. “I’ve come for the family planning service so I can space out my children,” she explained, highlighting the growing demand for reproductive health services in the country.
Sierra Leone is currently at a crossroads as lawmakers debate the controversial Safe Motherhood Bill, which seeks to legalize abortion and expand access to reproductive healthcare. The bill, introduced by President Julius Maada Bio, initially proposed allowing abortion up to 14 weeks of pregnancy. However, under pressure from religious groups, it has been amended to permit abortion only in cases of life-threatening risk, fatal fetal abnormalities, rape, or incest.
The stakes are high. Sierra Leone has one of the world’s highest teenage pregnancy rates, with over 20% of girls aged 15-19 becoming pregnant, according to the United Nations Population Fund. Unsafe abortions contribute to an estimated 10% of maternal deaths, a crisis worsened by restrictive abortion laws that force tens of thousands of women and girls to resort to dangerous methods.
One such woman, Fatou Esther Jusu, now 21, recalls her own harrowing experience. At 16, she attempted to self-induce an abortion using misoprostol from a local pharmacy. When the drug failed, she tried again and miscarried. “I was lucky,” she says, acknowledging that a friend of hers died after taking expired medication. Now a nursing student and reproductive rights activist, Jusu is advocating for legal reforms. “I don’t want other girls to go through what I did,” she says.
Despite opposition, healthcare workers argue that decriminalizing abortion could save lives by allowing women access to safe, professional medical care. Currently, doctors perform terminating procedures under different diagnoses to circumvent the colonial-era law. “If patients want an abortion, you cannot stop them,” says nurse Hawanatu Samura, who treats women suffering from botched procedures. She regularly sees cases of severe hemorrhaging caused by unsterilized instruments, particularly among teenage girls.
An estimated 90,000 abortions are performed annually in Sierra Leone, a country of more than 8 million people. With a maternal mortality rate of 717 deaths per 100,000 births—one of the highest in the world—activists insist that expanding reproductive rights is essential to reducing preventable deaths.
The government expects a vote on the bill in the coming weeks, but its passage remains uncertain. As Sierra Leone grapples with this divisive issue, women’s lives hang in the balance.
